In a survey of physicians at an academic medical center, researchers found that more than three quarters of physicians experienced a significant emotional stressor in their personal or professional life in the previous year, and that most preferred to receive support from colleagues, above all other support options. These findings are published online on November 21, in Archives of Surgery, a peer-reviewed journal published by the American Medical Association.
The study was prompted by the lack of research in the area of physician support. “We know that significant stress in the lives of physicians can have notable impact on the healthcare system, including patient care and safety, as well as cost,” said Jo Shapiro, MD, director of the Center for Professionalism and Peer Support at BWH. “What we didn’t know is how many physicians are regularly affected by these major stressors, what support they would like, and what the barriers are to their seeking support.”
The researchers administered a 56-item survey to three groups of physicians within an academic medical center. The groups included residents and attendings from emergency medicine, general surgery, and anesthesiology, totaling 108 participants. Survey items questioned the significant stressors physicians experienced, willingness to seek support for various stressors, barriers that might prevent them from seeking support, and where they would most like to receive support from.
Of the physicians surveyed, 79 percent reported being involved in either a serious adverse patient event (any unexpected outcome not due to the underlying medical condition) and/or experiencing a traumatic personal event within the preceding year. The physicians were asked whether they would be willing to seek support after the event: 67 percent would seek support after involvement in a medical error, and 63 percent would after an adverse patient event.
The survey showed a desire to seek support, while it also identified some perceived barriers to getting support after a major stressor. The most prominent reported barrier to seeking support was lack of time, at 89 percent, while other barriers included the potential stigma that may be associated with getting support, lack of confidentiality, and lack of access.
Physician colleagues were the most popular potential sources of support reported in the survey, at 88 percent, outnumbering traditional mechanisms such as the employee assistance program (29%) and mental health professionals (48%). “In looking at the potential barriers to seeking support, it made sense to us that physicians wanted to receive support directly from their peers who have experienced similar situations and emotions,” said Shapiro, also chief of the Otolaryngology Division at BWH. “We also know the physician culture is one that perpetuates the expectation that physicians cannot be vulnerable, making them concerned about confidentiality and the potential stigma associated with seeking help from mental health professionals, or other non-physicians.”
The researchers also believe that well supported clinicians will be better able to compassionately and transparently disclose adverse events to their patients and families. Previous studies have shown that physicians have difficulty disclosing medical errors to patients in part because the physicians feel afraid and ashamed, and currently lack support in their profession to manage these emotions.
The researchers note that these findings are important because the structure of support that physicians desire is currently not in place in healthcare settings in the US. In 2008, BWH established the Center for Professionalism and Peer Support, a one-of-a-kind program developed to provide the guidance and support that physicians lacked in their work environment.
“Our institution-wide program focuses both on the importance of professional behavior as well as supporting clinicians who have undergone a major stressor, particularly involvement in medical errors and adverse patient events,” said Shapiro. “We fundamentally believe that by supporting our physicians during stressful times, we will improve patient safety, care and outcomes.”
About the Center for Professionalism and Peer Support at BWH
Established in 2008, the Center for Professionalism and Peer Support at Brigham and Women’s Hospital is a program whose mission is to encourage and support physicians and other healthcare professionals in providing the highest quality compassionate care for every patient. The program’s founders believe that this kind of care occurs in a culture that values and promotes mutual respect, trust and teamwork. The Center promotes and expands such programs as the Professionalism Initiative, Peer Support, and a Disclosure and Apology Program.
At the heart of the Peer Support program is a network of clinicians trained to reach out to colleagues who have experienced an adverse patient event or have been named in a lawsuit, in order to immediately and proactively offer support. These trained peers also respond to clinicians who contact the center for support after any other professional or personal event. Collegiality and confidentiality drive the success of this program, as well as the others services offered through the Center. Learn more about the Center for Professionalism and Peer Support.
About Brigham and Women’s Hospital
Brigham and Women’s Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. BWH is the home of the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), www.brighamandwomens.org/research, BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 900 physician-investigators and renowned biomedical scientists and faculty supported by more than $537 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses’ and Physicians’ Health Studies and the Women’s Health Initiative. For more information about BWH, please visit www.brighamandwomens.org